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Calcium metabolism disorders in prostate cancer: Different manifestations
e154
Abstracts
its usefulness. Extensive screening has no demonstrated benefit and might actually cause harm. Methods: In total, 87 patients with acute pulmonary embolism and without known malignancy were studied. A diagnostic screening workup including a clinical history, physical examination, complete blood count, basic biochemistry panel including hepatic and renal function tests, prostate-specific antigen, a chest X-ray and an abdominopelvic ultrasonography was performed for all patients. Results: The routine “limited” screening was performed in all patients and revealed malignancy in 2 cases (2.3%). In 2 other patients (2.3%) malignancy was detected after initiation of anticoagulation therapy, one of them due to clinically insignificant bleeding. Conclusions: A limited diagnostic work-up for occult cancer in patients with pulmonary embolism has the capacity to identify approximately one-half of the malignancies. Anticoagulation treatment itself can detect additional cases of occult malignancy. doi:10.1016/j.ejim.2013.08.397
ID: 852 Autoimmune meningo-encephalitis secondary to anti-NMDAR: A paraneoplasic neurologic syndrome A. Peláez Ballesta, J. Hernández Roca, G. Lara Martinez, M. Molina Morales, E. Mene Fenor Internal Medicine, Rafael Mendez Hospital, Lorca, Spain
Introduction: Paraneoplasic neurologic syndromes are a heterogeneous group of disorders caused by mechanisms other than metastases, metabolic and nutritional deficits, infections, coagulopathy or side effects of cancer treatment. These syndromes may affect any part of the nervous system from cerebral cortex to neuromuscular junction and muscle, either damaging one area or multiple areas (encephalomyelitis). Case report: 24 year-old women, student, no personal history of interest, was admitted to psychiatric unit by conduct disorder and personality change. She describes depressed mood at work, with feelings of depersonalization and emotional lability, entering with agitation and anxiety box. Patient began with 38 grades of fever and she was consulted by internal medicine service. The day before, patient referred headache and chills. Objectively, she had good level of awareness, slight inattention, facial blankness, moderate bradypychia and cognition deficit, moderate dysarthria. General blood test, chest radiograph and electrocardiogram were requested, with normal results except elevated VSG. Lumbar puncture was performed with 95% of lymphocytosis and negative result by virus herpes and enterovirus. In the presence of unknown origin encephalopathy, study was continued. Cultives, serologies (VIH, VHC, VHB, Lues, Ricketsia, Borrelia B.) and mantoux were requested, with negative results, discarding infectious cause. Also, thyroid antibodies were negatives excluding thyroid cause. The autoimmunity test (ENAs, ANAs, antiDNA, ANCA), cerebral MR and angio-MR were negatives. While, patient's symptomatology was worse with: progressive loss of interaction, apathy, evolving to akinetic mutism, global hypertonia, dystonic postures fluctuating trend as opisthotonos, ocular retrovulsion crisis with unresponsiveness to stimuli and crying spells without connection to the middle. By clinical suspicion of paraneoplasic syndrome, serum antibodies antineuronal (anti-Hu, anti-Yo, anti CV2, anti-Ri y antiNMDAR), EEG (abundant theta and low delta activity), abdomen-pelvis CT, gynecological ultrasound and a new lumbar puncture with antibodies antineuronal (anti-NMDAR, anti-GABAR, anti VDKG) were performed. The results were: fluid lumbar puncture: predominance of mononuclear, normal protein and glucose, lymphocytosis, oligoclonal bands positives and antibodies anti NMDAR positives, without evidence of primary tumor. In this momento, treatment with immunoglobulins
and metilprednisolone iv begun. Patient improved progressively. 8 months after, patient has recovered its initial state, without finding associated tumor. Diagnostic: Anti-NMDAR encephalitis. doi:10.1016/j.ejim.2013.08.398
ID: 853 Microscopic polyangiitis as an early manifestation of pancreatic cancer N. Jacinto, C. Madaleno, P. Rocha, J. Meneses Santos Internal Medicine 2, Hospital Universitário de Sana Maria CHLN/HSM, Lisboa, Portugal
Microscopic polyangiitis is a rare condition characterized by necrotizing vasculitis of small vessels. It is associated with antineutrophil cytoplasm antibodies (ANCA) in 75% of cases and it is the most frequent cause of pulmonary–renal syndrome. The authors present a 70 year old female patient, admitted with complaints of asthenia, fever (38 °C), cough with purulent sputum and pleuritic chest pain for five days after a second course of antibiotics. She had pale skin and mucosae, with prolonged expiratory time and bilateral lung rales. Laboratory workup revealed normochromic normocytic anemia (8.0 g/dL), acute renal failure (creatinine clearance 15 mL/min), urea 90 mg/dL, polyuria (5.2 L/24 h) with proteinuria (1.4 g/24 h), C-reactive protein 8.3 mg/dL and erythrocyte sedimentation rate of 120 mm in the first hour. ANA, anti-dsDNA, rheumatoid factor and c-ANCA were negative; p-ANCA was positive (58 units for a normal cut-off value of 20); blood electrolytes and liver function were normal. Abdominal and kidney ultrasound were unchanged and chest CT showed bilateral ground glass opacification of lung parenchyma. Bronchial biopsy revealed a chronic nonspecific infiltrate in the lamina propria and the kidney biopsy showed lymphoplasmacytic infiltrate without peri-glomerular immunofluorescence deposits. Endoscopy, colonoscopy and myelogram were all normal. Rapidly progressive kidney failure due to crescentic glomerulonephritis type III secondary to microscopic polyangiitis was diagnosed and treated with cyclophosphamide, followed by azathioprine and prednisolone with resolution of complaints and analytical alterations. Twelve months later, the patient presented on follow-up consultation with elevated cholestatic enzymes (GGT 120 U/L, alkaline phosphatase 532 U/L) and bilirubin of 1.3 mg/dL. The abdominal tomography was repeated at this point, showing a solid pancreatic lesion (2.7 × 2, 5 cm) with multiple liver metastasis. The pancreatic lesion was biopsied and identified as pancreatic adenocarcinoma. The patient died 2 months after diagnosis. The authors present a case of a pancreatic adenocarcinoma preceded by microscopic polyangiitis by one year. ANCA associated vasculitis is related with malignity in 2–5%. The ANCA associated vasculitis cancer relation has been identified as paraneoplastic syndrome, fortuitous association or secondary to immunossupressors. Potential mechanisms for malignancy are dysfunction of the immune system associated with autoimmunity and cytotoxic drugs used for the management of vasculitis. doi:10.1016/j.ejim.2013.08.399
ID: 880 Calcium metabolism disorders in prostate cancer: Different manifestations F. Leal-Seabra, J. Malheiro, R. Pacheco, I. Da Costa Internal Medicine, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
Abstracts
Bone metastases from prostate cancer can have different behaviours. Their osteoclastic or osteoblastic activities are associated with calcium metabolism disorders: hyper and hypocalcemia, respectively. Case 1: 88-year-old male with arterial hypertension (HTN) and bone metastases from adenocarcinoma of the prostate (Prostatic-Specific antigen—PSA 2416 ng/mL) under therapy with bicalutamide. He was admitted with refusal to eat, psychomotor agitation and worsening of chronic kidney disease. He had 16.7 mg/dL of ionized calcium. Pamidronate was initiated with consequent improvement of symptoms and renal function. Case 2: 80-year-old male, smoker 240 pack-year, was admitted with acute renal failure secondary to rhabdomyolysis after a non-observed fall. He presented sudden dyspnea, accompanied by malaise, upper abdominal pain and generalized muscle weakness in the context of severe hypocalcemia (4.6 mg/dL). Etiologic study found bone metastasis of prostate adenocarcinoma (PSA 94.90 ng/mL). Replacement began with calcium carbonate and bicalutamide, with progressive improvement of symptoms. Bone metastasis due to prostate cancer may acquire different behaviours that influence the treatment choice and prognosis. doi:10.1016/j.ejim.2013.08.400
ID: 887 Paraneoplastic polymyalgia rheumatica—A surgically treatable disease? J. Tavares, V. Romão, G. Eugénio, S. Calretas, R. Santos, J. Nascimento Costa Medicina Interna, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
Introduction: Malignant neoplasm's are associated with a variety of paraneoplastic rheumatological syndromes. Polymyalgia rheumatica (PMR), a relatively common disease in the elderly, is characterized by stiffness and pain in the shoulders, neck, and hips. The association between PMR and cancer is controversial. Case presentation: A 82-yearold man was admitted to our hospital because of stiffness and pain in the shoulders with great limitation in his daily activities, for the last month. His past medical history included diabetes, osteoarthritis and hypertension. On physical examination, the patient had pain with movement and had decreased active range of motion of the shoulders. His blood tests showed normochromic, normocytic anaemia and ESR 84 mm/h. The diagnosis of PMR was made and deflazacort was prescribed, without achieving a complete symptom relief and with ERS levels of 53–59 mm/h. After 5 months the patient developed macroscopic haematuria. Further study led to the diagnosis of an infiltrative bladder urothelial carcinoma and prostate adenocarcinoma. The patient underwent radical cystectomy and prostatectomy. Meanwhile deflazacort was suspended due to a postoperative infection. He was re-evaluated 1.5 months after discharge, and was completely asymptomatic with an ESR level of 38 mm/h. Conclusion: The association between cancer and rheumatic disorders is a matter of discussion. The paraneoplastic nature is often based in a time-relation and in specific signs: rapid-onset of symptoms, atypical age, poor response to corticosteroids or immunosuppressive therapy, atypical distribution of involved joints, and abnormal laboratory tests. In the case described the initial lack of response, with improvement/ resolution of complaints after surgery seems to establish a relationship between the two situations suggesting that it is a paraneoplastic polymyalgia rheumatic. Recognition of a paraneoplastic rheumatic disease may permit early diagnosis and treatment of the underlying cancer. doi:10.1016/j.ejim.2013.08.401
e155
ID: 897 Splenic plasmablastic lymphoma A. Vilas-Boas, F. Teixeira-Andrade, N. Pereira, M. Honavar, R. Môço Internal Medicine, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
B-cell lymphomas with plasmablastic differentiation are a heterogeneous group of rare lymphomas that share the same morphology and/or immunophenotype but have distinct clinicopathologic and molecular features. This group includes diseases like anaplastic large cell lymphoma kinase (ALK) positive large B-cell lymphoma and human immunodeficiency virus (HIV) or human herpes virus-8 (HHV-8) associated lymphoma. A 63-year-old man with previously known arterial hypertension, dyslipidemia and coronary artery disease, was admitted to our hospital with symptomatic hypotension, fever and cutaneous erythema that started 2 months earlier. He had been previously treated for the rash with antihistamines and corticosteroids, topic and oral, without significant response. He also reported decreased appetite and nonquantified weight loss during the past year. On examination he had hypotension and fever and a pruriginous cutaneous erythema that spared only palms and plants. Blood tests revealed thrombocytopenia (86,000/μL), elevated erythrocyte sedimentation rate (37 mm/1st hour) and lactate dehydrogenase (400 U/L). Thoraco-abdominopelvic computed tomography showed a homogeneously enlarged spleen. Further investigation showed decreased cholesterol levels and increased immunoglobulin E. Immunophenotypic analysis of peripheral blood and bone marrow showed no evidence of neoplastic disease. During hospitalization the cutaneous erythema progressively disappeared and thrombocytopenia worsened to a minimum value of 8000/μL, without response to high-dose corticosteroids and platelet transfusion. Due to the refractory thrombocytopenia, the patient was submitted to laparoscopic splenectomy. After splenectomy the patient started to get better with normalization of platelet count. He also showed no more fever and systolic blood pressure raised to normal levels. Pathologic analysis of the spleen showed HHV-8 associated splenic plasmablastic lymphoma, stages I–E. The patient was also submitted to chemotherapy with cyclophosphamide, doxorubicin, prednisolone and rituximad with good response. Plasmablastic lymphomas are very rare diseases particularly in patients without HIV infection. It also affects more frequently the digestive tract, making this one of the few reported cases in the literature of this kind of lymphoma. The recognition of this complex condition with challenging diagnosis is important to avoid delay of treatment. doi:10.1016/j.ejim.2013.08.402
ID: 902 Paraneoplastic panuveitis Liliana Cunha, Marta Amaral, Filipe Paula, Irina Mocanu Medicina IV, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
Panuveitis is diffuse inflammation of the uveal tract of the entire eyeball that is often seen in association with systemic inflammatory diseases. We present a case report of a 63 year old men, active smoker, without any previous disease, that presented with reduced visual acuity in both eyes and blurred vision on the right, without any other symptom. On ophthalmologic observation it was found panuveitis in both eyes. Arteriography of the retinal vessels showed
Abstracts
its usefulness. Extensive screening has no demonstrated benefit and might actually cause harm. Methods: In total, 87 patients with acute pulmonary embolism and without known malignancy were studied. A diagnostic screening workup including a clinical history, physical examination, complete blood count, basic biochemistry panel including hepatic and renal function tests, prostate-specific antigen, a chest X-ray and an abdominopelvic ultrasonography was performed for all patients. Results: The routine “limited” screening was performed in all patients and revealed malignancy in 2 cases (2.3%). In 2 other patients (2.3%) malignancy was detected after initiation of anticoagulation therapy, one of them due to clinically insignificant bleeding. Conclusions: A limited diagnostic work-up for occult cancer in patients with pulmonary embolism has the capacity to identify approximately one-half of the malignancies. Anticoagulation treatment itself can detect additional cases of occult malignancy. doi:10.1016/j.ejim.2013.08.397
ID: 852 Autoimmune meningo-encephalitis secondary to anti-NMDAR: A paraneoplasic neurologic syndrome A. Peláez Ballesta, J. Hernández Roca, G. Lara Martinez, M. Molina Morales, E. Mene Fenor Internal Medicine, Rafael Mendez Hospital, Lorca, Spain
Introduction: Paraneoplasic neurologic syndromes are a heterogeneous group of disorders caused by mechanisms other than metastases, metabolic and nutritional deficits, infections, coagulopathy or side effects of cancer treatment. These syndromes may affect any part of the nervous system from cerebral cortex to neuromuscular junction and muscle, either damaging one area or multiple areas (encephalomyelitis). Case report: 24 year-old women, student, no personal history of interest, was admitted to psychiatric unit by conduct disorder and personality change. She describes depressed mood at work, with feelings of depersonalization and emotional lability, entering with agitation and anxiety box. Patient began with 38 grades of fever and she was consulted by internal medicine service. The day before, patient referred headache and chills. Objectively, she had good level of awareness, slight inattention, facial blankness, moderate bradypychia and cognition deficit, moderate dysarthria. General blood test, chest radiograph and electrocardiogram were requested, with normal results except elevated VSG. Lumbar puncture was performed with 95% of lymphocytosis and negative result by virus herpes and enterovirus. In the presence of unknown origin encephalopathy, study was continued. Cultives, serologies (VIH, VHC, VHB, Lues, Ricketsia, Borrelia B.) and mantoux were requested, with negative results, discarding infectious cause. Also, thyroid antibodies were negatives excluding thyroid cause. The autoimmunity test (ENAs, ANAs, antiDNA, ANCA), cerebral MR and angio-MR were negatives. While, patient's symptomatology was worse with: progressive loss of interaction, apathy, evolving to akinetic mutism, global hypertonia, dystonic postures fluctuating trend as opisthotonos, ocular retrovulsion crisis with unresponsiveness to stimuli and crying spells without connection to the middle. By clinical suspicion of paraneoplasic syndrome, serum antibodies antineuronal (anti-Hu, anti-Yo, anti CV2, anti-Ri y antiNMDAR), EEG (abundant theta and low delta activity), abdomen-pelvis CT, gynecological ultrasound and a new lumbar puncture with antibodies antineuronal (anti-NMDAR, anti-GABAR, anti VDKG) were performed. The results were: fluid lumbar puncture: predominance of mononuclear, normal protein and glucose, lymphocytosis, oligoclonal bands positives and antibodies anti NMDAR positives, without evidence of primary tumor. In this momento, treatment with immunoglobulins
and metilprednisolone iv begun. Patient improved progressively. 8 months after, patient has recovered its initial state, without finding associated tumor. Diagnostic: Anti-NMDAR encephalitis. doi:10.1016/j.ejim.2013.08.398
ID: 853 Microscopic polyangiitis as an early manifestation of pancreatic cancer N. Jacinto, C. Madaleno, P. Rocha, J. Meneses Santos Internal Medicine 2, Hospital Universitário de Sana Maria CHLN/HSM, Lisboa, Portugal
Microscopic polyangiitis is a rare condition characterized by necrotizing vasculitis of small vessels. It is associated with antineutrophil cytoplasm antibodies (ANCA) in 75% of cases and it is the most frequent cause of pulmonary–renal syndrome. The authors present a 70 year old female patient, admitted with complaints of asthenia, fever (38 °C), cough with purulent sputum and pleuritic chest pain for five days after a second course of antibiotics. She had pale skin and mucosae, with prolonged expiratory time and bilateral lung rales. Laboratory workup revealed normochromic normocytic anemia (8.0 g/dL), acute renal failure (creatinine clearance 15 mL/min), urea 90 mg/dL, polyuria (5.2 L/24 h) with proteinuria (1.4 g/24 h), C-reactive protein 8.3 mg/dL and erythrocyte sedimentation rate of 120 mm in the first hour. ANA, anti-dsDNA, rheumatoid factor and c-ANCA were negative; p-ANCA was positive (58 units for a normal cut-off value of 20); blood electrolytes and liver function were normal. Abdominal and kidney ultrasound were unchanged and chest CT showed bilateral ground glass opacification of lung parenchyma. Bronchial biopsy revealed a chronic nonspecific infiltrate in the lamina propria and the kidney biopsy showed lymphoplasmacytic infiltrate without peri-glomerular immunofluorescence deposits. Endoscopy, colonoscopy and myelogram were all normal. Rapidly progressive kidney failure due to crescentic glomerulonephritis type III secondary to microscopic polyangiitis was diagnosed and treated with cyclophosphamide, followed by azathioprine and prednisolone with resolution of complaints and analytical alterations. Twelve months later, the patient presented on follow-up consultation with elevated cholestatic enzymes (GGT 120 U/L, alkaline phosphatase 532 U/L) and bilirubin of 1.3 mg/dL. The abdominal tomography was repeated at this point, showing a solid pancreatic lesion (2.7 × 2, 5 cm) with multiple liver metastasis. The pancreatic lesion was biopsied and identified as pancreatic adenocarcinoma. The patient died 2 months after diagnosis. The authors present a case of a pancreatic adenocarcinoma preceded by microscopic polyangiitis by one year. ANCA associated vasculitis is related with malignity in 2–5%. The ANCA associated vasculitis cancer relation has been identified as paraneoplastic syndrome, fortuitous association or secondary to immunossupressors. Potential mechanisms for malignancy are dysfunction of the immune system associated with autoimmunity and cytotoxic drugs used for the management of vasculitis. doi:10.1016/j.ejim.2013.08.399
ID: 880 Calcium metabolism disorders in prostate cancer: Different manifestations F. Leal-Seabra, J. Malheiro, R. Pacheco, I. Da Costa Internal Medicine, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
Abstracts
Bone metastases from prostate cancer can have different behaviours. Their osteoclastic or osteoblastic activities are associated with calcium metabolism disorders: hyper and hypocalcemia, respectively. Case 1: 88-year-old male with arterial hypertension (HTN) and bone metastases from adenocarcinoma of the prostate (Prostatic-Specific antigen—PSA 2416 ng/mL) under therapy with bicalutamide. He was admitted with refusal to eat, psychomotor agitation and worsening of chronic kidney disease. He had 16.7 mg/dL of ionized calcium. Pamidronate was initiated with consequent improvement of symptoms and renal function. Case 2: 80-year-old male, smoker 240 pack-year, was admitted with acute renal failure secondary to rhabdomyolysis after a non-observed fall. He presented sudden dyspnea, accompanied by malaise, upper abdominal pain and generalized muscle weakness in the context of severe hypocalcemia (4.6 mg/dL). Etiologic study found bone metastasis of prostate adenocarcinoma (PSA 94.90 ng/mL). Replacement began with calcium carbonate and bicalutamide, with progressive improvement of symptoms. Bone metastasis due to prostate cancer may acquire different behaviours that influence the treatment choice and prognosis. doi:10.1016/j.ejim.2013.08.400
ID: 887 Paraneoplastic polymyalgia rheumatica—A surgically treatable disease? J. Tavares, V. Romão, G. Eugénio, S. Calretas, R. Santos, J. Nascimento Costa Medicina Interna, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
Introduction: Malignant neoplasm's are associated with a variety of paraneoplastic rheumatological syndromes. Polymyalgia rheumatica (PMR), a relatively common disease in the elderly, is characterized by stiffness and pain in the shoulders, neck, and hips. The association between PMR and cancer is controversial. Case presentation: A 82-yearold man was admitted to our hospital because of stiffness and pain in the shoulders with great limitation in his daily activities, for the last month. His past medical history included diabetes, osteoarthritis and hypertension. On physical examination, the patient had pain with movement and had decreased active range of motion of the shoulders. His blood tests showed normochromic, normocytic anaemia and ESR 84 mm/h. The diagnosis of PMR was made and deflazacort was prescribed, without achieving a complete symptom relief and with ERS levels of 53–59 mm/h. After 5 months the patient developed macroscopic haematuria. Further study led to the diagnosis of an infiltrative bladder urothelial carcinoma and prostate adenocarcinoma. The patient underwent radical cystectomy and prostatectomy. Meanwhile deflazacort was suspended due to a postoperative infection. He was re-evaluated 1.5 months after discharge, and was completely asymptomatic with an ESR level of 38 mm/h. Conclusion: The association between cancer and rheumatic disorders is a matter of discussion. The paraneoplastic nature is often based in a time-relation and in specific signs: rapid-onset of symptoms, atypical age, poor response to corticosteroids or immunosuppressive therapy, atypical distribution of involved joints, and abnormal laboratory tests. In the case described the initial lack of response, with improvement/ resolution of complaints after surgery seems to establish a relationship between the two situations suggesting that it is a paraneoplastic polymyalgia rheumatic. Recognition of a paraneoplastic rheumatic disease may permit early diagnosis and treatment of the underlying cancer. doi:10.1016/j.ejim.2013.08.401
e155
ID: 897 Splenic plasmablastic lymphoma A. Vilas-Boas, F. Teixeira-Andrade, N. Pereira, M. Honavar, R. Môço Internal Medicine, Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
B-cell lymphomas with plasmablastic differentiation are a heterogeneous group of rare lymphomas that share the same morphology and/or immunophenotype but have distinct clinicopathologic and molecular features. This group includes diseases like anaplastic large cell lymphoma kinase (ALK) positive large B-cell lymphoma and human immunodeficiency virus (HIV) or human herpes virus-8 (HHV-8) associated lymphoma. A 63-year-old man with previously known arterial hypertension, dyslipidemia and coronary artery disease, was admitted to our hospital with symptomatic hypotension, fever and cutaneous erythema that started 2 months earlier. He had been previously treated for the rash with antihistamines and corticosteroids, topic and oral, without significant response. He also reported decreased appetite and nonquantified weight loss during the past year. On examination he had hypotension and fever and a pruriginous cutaneous erythema that spared only palms and plants. Blood tests revealed thrombocytopenia (86,000/μL), elevated erythrocyte sedimentation rate (37 mm/1st hour) and lactate dehydrogenase (400 U/L). Thoraco-abdominopelvic computed tomography showed a homogeneously enlarged spleen. Further investigation showed decreased cholesterol levels and increased immunoglobulin E. Immunophenotypic analysis of peripheral blood and bone marrow showed no evidence of neoplastic disease. During hospitalization the cutaneous erythema progressively disappeared and thrombocytopenia worsened to a minimum value of 8000/μL, without response to high-dose corticosteroids and platelet transfusion. Due to the refractory thrombocytopenia, the patient was submitted to laparoscopic splenectomy. After splenectomy the patient started to get better with normalization of platelet count. He also showed no more fever and systolic blood pressure raised to normal levels. Pathologic analysis of the spleen showed HHV-8 associated splenic plasmablastic lymphoma, stages I–E. The patient was also submitted to chemotherapy with cyclophosphamide, doxorubicin, prednisolone and rituximad with good response. Plasmablastic lymphomas are very rare diseases particularly in patients without HIV infection. It also affects more frequently the digestive tract, making this one of the few reported cases in the literature of this kind of lymphoma. The recognition of this complex condition with challenging diagnosis is important to avoid delay of treatment. doi:10.1016/j.ejim.2013.08.402
ID: 902 Paraneoplastic panuveitis Liliana Cunha, Marta Amaral, Filipe Paula, Irina Mocanu Medicina IV, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
Panuveitis is diffuse inflammation of the uveal tract of the entire eyeball that is often seen in association with systemic inflammatory diseases. We present a case report of a 63 year old men, active smoker, without any previous disease, that presented with reduced visual acuity in both eyes and blurred vision on the right, without any other symptom. On ophthalmologic observation it was found panuveitis in both eyes. Arteriography of the retinal vessels showed